Incidence, Mortality, Survival, and Prevalence in 2012

pISSN 1598-2998, eISSN 2005-9256

Cancer Res Treat. 2015;47(2):127-141 http://dx.doi.org/10.4143/crt.2015.060

Special Article Open Access pISSN 1598-2998 eISSN 2005-9256 http://www.e-crt.org Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2012

Kyu-Won Jung, MS1,2 Purpose Young-Joo Won, PhD1,2 The aim of this study was to report nationwide cancer statistics in Korea, including incidence, mortality, survival, and prevalence, and their trends. Hyun-Joo Kong, MS1,2 Chang-Mo Oh, MD, PhD1,2 Materials and Methods Hyunsoon Cho, PhD1,2 Incidence data from 1993 to 2012 were obtained from the Korea National Cancer Duk Hyoung Lee, MD, PhD2 Incidence Database, and vital status was followed through December 31, 2013. Kang Hyun Lee, MD, PhD1 Mortality data from 1983 to 2012 were obtained from Statistics Korea. Crude and age-standardized rates for incidence, mortality, and prevalence, and relative survival were calculated. Results A total of 224,177 cancer cases and 73,759 cancer deaths were reported in 2012, and there were 1,234,879 prevalent cases identified in Korea as of January 1, 2013. Over the past 14 years (1999-2012), overall incidence rates have increased by 3.3% 1The Korea Central Cancer Registry and per year. The incidence rates of liver and cervical cancers have decreased, while those 2 National Cancer Control Institute, of thyroid, breast, prostate, and colorectal cancers have increased. Notably, incidence National Cancer Center, Goyang, Korea of thyroid cancer increased by 22.3% per year in both sexes and has been the most common cancer since 2009. The mortality for all cancers combined decreased by 2.7% per year from 2002 to 2012. Five-year relative survival rates of patients diagnosed in the last 5 years (2008-2012) have improved by 26.9% compared with those from 1993 to1995. + + + + + + + + + + + + + + + + + + + + Conclusion + C +o r+re s+p o +n d +e n +c e :+ Y +ou +ng -+J o +o W + o +n , +Ph +D + + + + + T +h e + K o+r e+a C+e n+t r +al C+a n+c e+r R+e g+i s t+ry +, + + + + + Overall cancer mortality rates have declined since 2002 in Korea, while incidence + N +a t+io n+a l+ C a+n c+e r +C e+n t e+r , +3 2 +3 I l+s a +n- r+o , + + + + + has increased and survival has improved. + I l+s a +nd +on +g- g+u ,+ G o+y a+n g+ 4 1+0 -+76 9+, K+o r+e a + + + + + + T +e l :+ 8 2 +-3 1+- 9 +20 -+2 0 +15 + + + + + + + + + + + + + F +a x +: 8 2+- 3 +1- 9+2 0 +-2 1+7 9 + + + + + + + + + + + + + E +-m +a i l+: a +st r +a6 7+@ +nc c+.r e+.k r+ + + + + + + + + + Key words + + + + + + + + + + + + + + + + + + + + Incidence, Mortality, Survival, Prevalence, Neoplasms, Korea + R +e c +ei v +e d + F +eb r+u a+r y + 1 7 +, 2 +01 5+ + + + + + + + + + A +c c +e p +te d + F +e b +ru a+r y + 2 2+, 2 +0 1 +5 + + + + + + + + + P +u b +li s +h e d+ o +n l i+n e + M +a r+c h + 3 , +2 0 1+5 + + + + + + + + + + + + + + + + + + + + + + + + + + +

Introduction 1. Data sources

The Ministry of Health and Welfare, Korea, initiated a Cancer has been the leading cause of death in Korea since nationwide hospital-based cancer registry called the Korea 1983 [1] and is the most burdensome disease [2]. More than Central Cancer Registry (KCCR) in 1980. The registry 210,000 new cancer cases are diagnosed in Korea each year, collected 80%-90% of cancer cases annually from more than and cancer is responsible for one in four deaths [3]. This 180 training hospitals throughout the country. article reports the most recent nationwide cancer statistics in In 1999, the KCCR expanded cancer registration to cover Korea, including incidence, mortality, survival, prevalence, the entire population under the Population-Based Regional and their trends. Cancer Registry Program. Details of the history, objectives,

│ http://www.e-crt.org │ Copyright ⓒ 2015 by the Korean Cancer Association 127 This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Cancer Res Treat. 2015;47(2):127-141

Table 1. Cancer incidence, prevalence, and deaths by sex in Korea, 2012

New cases Deaths Prevalent casesa) Site/Type Both Male Female Both Male Female Both Male Female All sites 224,177 112,385 111,792 73,759 46,462 27,297 1,234,879 547,837 687,042 Lip, oral cavity, 2,913 2,135 778 1,036 809 227 17,024 11,501 5,523 and pharynx Esophagus 2,332 2,116 216 1,398 1,278 120 7,444 6,714 730 Stomach 30,847 20,839 10,008 9,342 6,090 3,252 207,145 137,655 69,490 Colon and rectum 28,988 17,445 11,543 8,135 4,666 3,469 173,459 103,488 69,971 Liver 16,254 12,152 4,102 11,335 8,494 2,841 51,402 38,434 12,968 Gallbladderb) 5,131 2,600 2,531 3,688 1,818 1,870 14,778 7,532 7,246 Pancreas 5,403 2,940 2,463 4,778 2,616 2,162 7,032 3,803 3,229 Larynx 1,099 1,036 63 412 389 23 8,600 8,076 524 Lung 22,118 15,367 6,751 16,654 12,175 4,479 53,480 34,422 19,058 Breast 16,589 68 16,521 2,013 20 1,993 132,139 558 131,581 Cervix uteri 3,584 - 3,584 889 - 889 43,523 - 43,523 Corpus uteri 1,979 - 1,979 244 - 244 15,191 - 15,191 Ovary 2,167 - 2,167 910 - 910 14,171 - 14,171 Prostate 9,258 9,258 - 1,460 1,460 - 49,007 49,007 - Testis 243 243 - 13 13 - 2,210 2,210 - Kidney 4,152 2,882 1,270 917 663 254 26,015 17,551 8,464 Bladder 3,485 2,798 687 1,221 918 303 25,497 20,754 4,743 Brain and CNS 1,703 933 770 1,186 619 567 8,626 4,508 4,118 Thyroid 44,007 8,052 35,955 373 127 246 258,795 40,921 217,874 Hodgkin lymphoma 264 177 87 64 44 20 2,006 1,281 725 Non-Hodgkin lymphoma 4,553 2,542 2,011 1,523 920 603 26,426 14,299 12,127 Multiple myeloma 1,272 696 576 823 472 351 3,842 2,042 1,800 Leukemia 2,826 1,595 1,231 1,666 919 747 14,890 8,216 6,674 Other and ill-defined 13,010 6,511 6,499 3,679 1,952 1,727 72,177 34,865 37,312 CNS, central nervous system. a)Limited-duration prevalent cases on January 1, 2013; These patients who were diagnosed between January 1, 1999 and December 31, 2012 and were alive on January 1, 2013; Multiple primary cancer cases were counted multiple times, b)Includes the gallbladder and other/unspecified parts of the biliary tract.

and activities of the KCCR have been documented elsewhere tion on July 1 of specified years. [4]. Incidence data for 1999-2012 were obtained from the Korea National Cancer Incidence Database (KNCI DB). The 2. Analysis completeness of incidence data for 2012 was 97.7%, as determined by the Ajiki method [5]. Crude rates (CRs) and age-specific rates of cancer inci- Cancer cases were classified according to the International dence and mortality were calculated. Age-standardized rates Classification of Diseases for Oncology, third edition [6] and (ASRs) were calculated using Segi’s world standard popula- converted according to the International Classification of tion [8]. Cumulative risks of cancer, which represent the Diseases, 10th edition (ICD-10) [7]. A total of 2,405,894 cancer probability of developing cancer during one’s lifetime, were cases first diagnosed between 1993 and 2012 from the KNCI also calculated. Changes in the annual ASRs of cancer inci- DB were used in the survival analysis, and vital status was dence were examined by calculating the annual percentage followed until December 31, 2013. change over a time period as (exp(b)–1)100, where b is the Mortality data from 1983 to 2012 were obtained from slope of the regression of log ASR for a given calendar year Statistics Korea [1]. Cause of death was coded and classified [9]. according to ICD-10 [7]. Population data were also obtained Prevalence was also calculated for assessment of cancer from Statistics Korea using the resident registration popula- burden, which includes new and pre-existing cancer patients

128 CANCER RESEARCH AND TREATMENT Kyu-Won Jung, Cancer Statistics in Korea, 2012

Table 2. Crude and age-standardized cancer incidence rates by sex in Korea, 2012

Crude incidence rate Age-standardized incidence rate Site/Type per 100,000 per 100,000a) Both Male Female Both Male Female All sites 445.3 446.2 444.4 299.0 326.4 290.1 Lip, oral cavity, and pharynx 5.8 8.5 3.1 3.9 6.1 2.0 Esophagus 4.6 8.4 0.9 3.0 6.1 0.5 Stomach 61.3 82.7 39.8 39.9 59.3 23.5 Colon and rectum 57.6 69.3 45.9 37.3 50.0 26.8 Liver 32.3 48.2 16.3 21.1 34.3 9.5 Gallbladderb) 10.2 10.3 10.1 6.3 7.6 5.3 Pancreas 10.7 11.7 9.8 6.7 8.4 5.4 Larynx 2.2 4.1 0.3 1.4 3.0 0.1 Lung 43.9 61.0 26.8 27.4 44.3 14.9 Breast 33.0 0.3 65.7 22.6 0.2 44.7 Cervix uteri 7.1 - 14.2 4.9 - 9.5 Corpus uteri 3.9 - 7.9 2.7 - 5.3 Ovary 4.3 - 8.6 3.1 - 6.0 Prostate 18.4 36.8 - 11.6 27.0 - Testis 0.5 1.0 - 0.5 0.9 - Kidney 8.2 11.4 5.0 5.6 8.2 3.2 Bladder 6.9 11.1 2.7 4.3 8.1 1.4 Brain and CNS 3.4 3.7 3.1 2.8 3.3 2.4 Thyroid 87.4 32.0 142.9 62.5 23.0 102.4 Hodgkin lymphoma 0.5 0.7 0.3 0.5 0.6 0.3 Non-Hodgkin lymphoma 9.0 10.1 8.0 6.6 7.9 5.6 Multiple myeloma 2.5 2.8 2.3 1.6 2.0 1.4 Leukemia 5.6 6.3 4.9 4.9 5.9 4.1 Other and ill-defined 25.8 25.9 25.8 17.6 20.1 15.7 CNS, central nervous system. a)Age-adjusted using the world standard population, b)Includes the gallbladder and other/ unspecified parts of the biliary tract.

diagnosed during a given time period who were still alive table method and relative survival rates using the Ederer II on an index date. Using the cancer incidence database data method [11] were based on an algorithm written in SAS by from 1999 to 2012, we defined prevalent cases as patients Paul Dickman [12], with some minor modifications. who were diagnosed between January 1, 1999 and December 31, 2012, and were still alive on January 1, 2013. We calculated limited-duration prevalences, namely, 1- and 5-year prevalences. For example, the 5-year prevalence was calcu- Selected Findings lated as the number of people alive on January 1, 2013 who had been diagnosed with cancer within the previous 5 years. We applied this counting method using the SEER*Stat soft- 1. Incidence ware [10] to calculate the number of cases while adjusting for patients lost to follow-up. The overall number of incident cancer cases, deaths, and The survival duration for each case was determined as the prevalent cases by sex and cancer site for 2012 in Korea are interval between the date of initial diagnosis and the date of shown in Table 1. A total of 224,177 incident cancer cases and death, date of loss to follow-up, or closing date for follow- 73,759 deaths were reported to occur in 2012. As of January up. Observed survival rates were calculated using the life- 1, 2013, 1,234,879 prevalent cancer cases diagnosed between

VOLUME 47 NUMBER 2 APRIL 2015 129 Cancer Res Treat. 2015;47(2):127-141

Table 3. The top 10 leading causes of death in Korea, 2012

Age-standardized death rate Rank Cause of death No. of deaths Percentage of all deaths per 100,000a) All causes 267,221 100.0 326.6 1 Cancer 73,759 27.6 90.2 2 Heart disease 26,442 9.9 30.7 3 Cerebrovascular disease 25,744 9.6 29.0 4 Intentional self-harm (suicide) 14,160 5.3 20.4 5 Diabetes mellitus 11,557 4.3 13.2 6 Pneumonia 10,314 3.9 11.4 7 Chronic lower respiratory diseases 7,831 2.9 8.5 8 Disease of liver 6,793 2.5 8.8 9 Transport accidents 6,502 2.4 9.6 10 Hypertensive diseases 5,239 2.0 5.8 Others 78,880 29.6 99.2 Source: Mortality Data, 2012, Statistics Korea [1]. a)Age-adjusted using the world standard population.

1999 and 2012 were identified. The cumulative risk of devel- 350 oping cancer during one’s lifetime in 2012 was 37.5% for Male incidence males and 34.9% for females. 300 The cancer incidence rates in 2012 by sex and cancer site Both sexes incidence are shown in Table 2. The 2012 CRs per 100,000 of all sites 0 250 0 0 , combined were 446.2 and 444.4 for males and females, 0 0

1 200

respectively. The ASRs per 100,000 of all sites combined were r Female incidence

e Male mortality p 326.4 and 290.1 for males and females, respectively. In males, e

t 150 a the five leading primary cancer sites were stomach (CR, 82.7; R Both sexes mortality ASR, 59.3), colon and rectum (CR, 69.3; ASR, 50.0), lung (CR, 100 61.0; ASR, 44.3), liver (CR, 48.2; ASR, 34.3), and prostate (CR, 36.8; ASR, 27.0), which together accounted for 66.8% of all 50 Female mortality newly diagnosed cancers in 2012. In females, the most common cancer site was thyroid (CR, 142.9; ASR, 102.4), followed 0 1983 1988 1992 1996 2000 2004 2008 2012 by breast (CR, 65.7; ASR, 44.7), colon and rectum (CR, 45.9; Year ASR, 26.8), stomach (CR, 39.8; ASR, 23.5), and lung (CR, 26.8; ASR, 14.9), which together accounted for 72.3% of all newly Fig. 1. Annual age-standardized cancer incidence and diagnosed cancers. Thyroid cancer alone accounted for 32.2% death rates by sex for all sites from 1983 to 2012 in Korea. of incident cases (n=35,955) among females in 2012. Age standardization was based on the world standard population. 2. Mortality

A total of 73,759 cancer deaths were reported in Korea for 24.1), stomach (CR, 24.2; ASR, 17.6), colon and rectum (CR, 2012, accounting for 27.6% of all deaths (Table 3). In 2012, the 18.5; ASR, 13.7), and pancreas (CR, 10.4; ASR, 7.6). In women, CRs per 100,000 for all sites combined were 184.5 and 108.5 lung cancer (CR, 17.8; ASR, 8.9) was the leading cause of in males and females, respectively. The ASRs per 100,000 for cancer death in 2012, followed by colon and rectum (CR, 13.8; all sites combined were 135.2 and 57.7 for males and females, ASR, 6.8), stomach (CR, 12.9; ASR, 6.5), liver (CR, 11.3; ASR, respectively. Cancers of the lung, liver, stomach, and 6.1), and pancreas (CR, 8.6; ASR, 4.4). colon/rectum were the main causes of cancer death, together accounting for approximately 61.6% of all cancer deaths in 3. Trends in cancer incidence 2012 (Table 4). In males, the five most common sites of cancer death in The cancer incidence rates from 1999 to 2012 in Korea 2012 were lung (CR, 48.3; ASR, 35.1), liver (CR, 33.7; ASR, for all sites combined and for selected sites are shown in

130 CANCER RESEARCH AND TREATMENT Kyu-Won Jung, Cancer Statistics in Korea, 2012

Table 4. Crude and age-standardized cancer mortality rates by sex in Korea, 2012

Crude mortality rate Age-standardized mortality rate Site/Type per 100,000 per 100,000a) Both Male Female Both Male Female All sites 146.5 184.5 108.5 90.2 135.2 57.7 Lip, oral cavity, and pharynx 2.1 3.2 0.9 1.3 2.3 0.5 Esophagus 2.8 5.1 0.5 1.7 3.7 0.2 Stomach 18.6 24.2 12.9 11.2 17.6 6.5 Colon and rectum 16.2 18.5 13.8 9.7 13.7 6.8 Liver 22.5 33.7 11.3 14.4 24.1 6.1 Gallbladderb) 7.3 7.2 7.4 4.3 5.3 3.6 Pancreas 9.5 10.4 8.6 5.8 7.6 4.4 Larynx 0.8 1.5 0.1 0.5 1.1 0.0 Lung 33.1 48.3 17.8 19.8 35.1 8.9 Breast 4.0 0.1 7.9 2.6 0.1 5.1 Cervix uteri 1.8 - 3.5 1.1 - 2.0 Corpus uteri 0.5 - 1.0 0.3 - 0.6 Ovary 1.8 - 3.6 1.2 - 2.2 Prostate 2.9 5.8 - 1.6 4.5 - Testis 0.0 0.1 - 0.0 0.0 - Kidney 1.8 2.6 1.0 1.1 1.9 0.5 Bladder 2.4 3.6 1.2 1.3 2.8 0.5 Brain and CNS 2.4 2.5 2.3 1.8 2.0 1.6 Thyroid 0.7 0.5 1.0 0.4 0.4 0.5 Hodgkin lymphoma 0.1 0.2 0.1 0.1 0.1 0.1 Non-Hodgkin lymphoma 3.0 3.7 2.4 1.9 2.7 1.3 Multiple myeloma 1.6 1.9 1.4 1.0 1.4 0.8 Leukemia 3.3 3.6 3.0 2.4 3.0 2.0 Other and ill-defined 7.3 7.7 6.9 4.6 5.9 3.7 CNS, central nervous system. a)Age-adjusted using the world standard population, b)Includes the gallbladder and other/ unspecified parts of the biliary tract.

A B 120 120 Stomach Colon and rectum Stomach Liver Lung Colon and rectum 0 Prostate Thyroid 0 Liver 0 100 0 100 0 0 , , Lung 0 0 0 0 Breast 1 1

r r Cervix uteri e 80 e 80 p p

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0 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Year of diagnosis Year of diagnosis

Fig. 2. Trends in age-standardized incidences of selected cancers by sex from 1999 to 2012 in Korea. Age standardization was based on the world standard population. (A) Male. (B) Female.

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134 CANCER RESEARCH AND TREATMENT Kyu-Won Jung, Cancer Statistics in Korea, 2012

Table 8. The five major sites of cancer incidence by age group and sex in Korea, 2012

Age (yr) Rank 0-14 15-34 35-64 ≥65 Male 1 Leukemia Thyroid Stomach Lung (4.8) (15.4) (95.3) (441.3) 2 Brain and CNS Leukemia Colon and rectum Stomach (2.4) (3.1) (77.1) (412.5) 3 Non-Hodgkin lymphoma Colon and rectum Liver Colon and rectum (2.3) (3.1) (63.3) (354.9) 4 Kidney Non-Hodgkin lymphoma Thyroid Prostate (0.5) (2.8) (53.1) (293.7) 5 Liver Stomach Lung Liver (0.4) (2.4) (42.7) (202.8) Female 1 Leukemia Thyroid Thyroid Colon and rectum (3.4) (69.6) (246.2) (184.1) 2 Non-Hodgkin lymphoma Breast Breast Stomach (1.8) (10.8) (119.3) (155.4) 3 Brain and CNS Cervix uteri Colon and rectum Lung (1.7) (5.2) (45.3) (125.5) 4 Ovarya) Stomach Stomach Thyroid (0.9) (3.8) (39.7) (102.3) 5 Thyroida) Ovary Lung Liver (0.9) (3.0) (21.8) (71.8) CNS, central nervous system. a)The incidence rates of ovarian and thyroid cancer are the same in the 0-14 age group.

Tables 5-7. The incidence for all sites combined increased by increases in cancer incidence, particularly among elderly 3.3% per year (1.5% in males, 5.3% in females) from 1999 to patients. 2012. The increase in cancer incidence is also illustrated in The incidence of some cancer sites in 2012, including stom- Fig. 1. ach, colon and rectum, decreased compared to 2011. How- The incidence rates for colorectal and thyroid cancers have ever, these trends could be causes of random error, therefore, continued to increase in both sexes, as have those for prostate these results should be interpreted with caution. cancer in males and breast cancer in females (Fig. 2). In contrast, the incidences of liver cancer in both sexes, lung 4. Age-specific incidence rates cancer in males, and cervical cancer in females have decreased. Notably, thyroid cancer increased rapidly, by The most common cancer sites by sex and age group in 22.3% per year in both sexes, and has been the most common 2012 are shown in Table 8. Leukemia and thyroid cancer cancer since 2009. Improvements in the sensitivity of diag- were the most common cancer in both sexes in patients aged nostic techniques for thyroid cancer, such as the advent of 0-14 and 15-34 years, respectively. For males, stomach cancer ultrasound and fine-needle aspiration, have enabled detec- was the most common cancer in those aged 35-64, while lung tion of small-sized thyroid cancers, and screening rates have cancer was more frequent among patients aged 65 and over. increased. Therefore, the increased incidence of thyroid Thyroid cancer was the most common cancer in females aged cancer might reflect the identification of previously unde- 35-64 years, and colorectal cancer was the most common tected diseases rather than a true increase in the occurrence cancer among older females aged 65 and over. of thyroid cancer [13-16]. In addition, due to the construction The age-specific incidence rates for selected cancers in of a 1999-2012 KNCI DB, the completeness of the Korean males and females in 2012 are shown in Fig. 3. The graphs cancer registry data has shown gradual improvement, and show that the incidences of stomach, lung, liver, and colorec- this may have contributed, in part, to the gradual overall tal cancers increased gradually with age. Incidences of breast

VOLUME 47 NUMBER 2 APRIL 2015 135 Cancer Res Treat. 2015;47(2):127-141

A B 800 350 Stomach Stomach 700 Colon and rectum Colon and rectum Liver 300 Liver 0 0

0 Lung 0 Lung 0 0 , 600 , 0 Prostate 0 Breast

0 0 250 1 1

r Thyroid r Cervix uteri

e 500 e

p p Thyroid 200 e e t t a a

r 400 r

c c i i

f f 150 i i

c 300 c e e p p s s

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0 0 4 9 4 9 4 9 4 9 4 9 4 9 4 9 4 9 4 ≤ 4 9 4 9 4 9 4 9 4 9 4 9 4 9 4 9 4 ≤ -0 -0 -1 -1 -2 -2 -3 -3 -4 -4 -5 -5 -6 -6 -7 -7 -8 5 -0 -0 -1 -1 -2 -2 -3 -3 -4 -4 -5 -5 -6 -6 -7 -7 -8 5 00 05 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 8 00 05 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 8 Age group (yr) Age group (yr)

Fig. 3. Age-specific incidence rates of major cancers for 2012 in Korea. (A) Male. (B) Female.

A B 80 Stomach 40 Stomach Colon and rectum Colon and rectum

0 Liver 0 Liver 0 0 0 0

, Lung , Lung 0 0

0 60 Prostate 0 30 Breast 1 1

r Thyroid r Cervix uteri e e p p Thyroid e e t t a a r r

d 40 d 20 e e z z i i d d r r a a d d n n a a t 20 t 10 s s - - e e g g A A

0 0 1983 1988 1992 1996 2000 2004 2008 2012 1983 1988 1992 1996 2000 2004 2008 2012 Year of death Year of death

Fig. 4. Annual age-standardized cancer mortalities of selected cancers by sex from 1983 to 2012 in Korea. Age standardization was based on the world standard population. (A) Male. (B) Female.

and thyroid cancers in females were highest among patients sexes since 2002. Lung cancer surpassed stomach cancer as in their late 40s and early 50s, respectively, and leveled off the leading cause of cancer death in 1999 and is expected to thereafter. The age-specific pattern of breast cancer is differ- account for 22.6% of all cancer deaths in 2012. However, the ent from those in Western countries [17]. ASRs of mortality due to lung cancer have decreased slightly in both males and females since 2002. The ASRs of mortality 5. Trends in cancer mortality due to stomach and cervical cancers have also shown a continuous decrease. Along with significant increases in The trends in cancer deaths for all sites combined and for prostate and female breast cancer incidence rates, mortality selected sites are shown in Figs. 1 and 4. ASRs of mortality rates of these cancers have also continued to increase. for all sites combined decreased by 2.7% per year in both

136 CANCER RESEARCH AND TREATMENT Kyu-Won Jung, Cancer Statistics in Korea, 2012 d ) e a i e f i g 2 8 2 2 0 3 8 4 2 5 0 1 6 9 0 8 8 4 6 7 4 6 7 c ...... - - n e 9 0 3 4 4 3 2 5 3 6 1 4 4 4 1 5 3 2 3 3 7 7 5 a – 2 1 1 1 1 1 2 1 1 2 2 1 2 1 1 p h s C n u - / 2 6 3 6 2 3 3 9 9 0 5 3 0 5 7 9 1 2 0 4 0 8 3 2 ...... 8 r 1 7 6 9 9 8 1 0 6 1 1 6 4 0 3 9 3 7 9 1 7 0 1 9 0 - - e 0 2 7 6 2 9 8 8 6 8 6 4 0 8 6 7 3 4 7 3 7 7 2 0 h 2 1 2 t o

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a e l r l n y b r h r r n s u l o d e a o u t p a v o o o v t l a i e o o N a e h a u i r i l r e s i a r a t P L S A L L B C C O P T K B B T H N M L E O S C L G C p T

VOLUME 47 NUMBER 2 APRIL 2015 137 Cancer Res Treat. 2015;47(2):127-141

AB 100 100 1999 1999 2000 2000 80 2001 80 2001 2002 2002 ) 2003 ) 2003 % % ( (

2004 2004 l l

a 60 2005 a 60 2005 v v i i

v 2006 v 2006 r r

u 2007 u 2007 s s

e 2008 e 2008 v v i 40 2009 i 40 2009 t t a a

l 2010 l 2010 e e

R 2011 R 2011 2012 2012 20 20

0 0 034567891 2 10 034567891 2 10 Year after diagnosis Year after diagnosis

Fig. 5. Trends in relative survival by year of diagnosis from 1999 to 2012. (A) All sites for both sexes. (B) All sites except thyroid cancer for both sexes.

Thyroid

Stomach

Colon and rectum

Breast

Lung

Liver

Prostate

Cervix uteri

Non-Hodgkin lymphoma

Kidney

0 40,000 80,000 120,000 160,000 200,000 240,000 280,000

Cancer prevalent cases Non- Colon and All Thyroid Stomach Breast Lung LiverProstate Cervix uteri Hodgkin Kidney rectum cancers lymphoma Under 1 yr 43,791 27,781 26,663 16,384 15,297 11,531 8,976 3,430 3,893 3,841 196,987 1-2 yr 40,697 25,167 23,559 15,584 9,366 8,198 8,329 3,314 3,261 3,387 167,992 2-5 yr 94,531 59,471 53,285 37,689 14,411 15,698 17,976 9,384 7,487 7,948 377,010 5-14 yr 79,776 94,726 69,952 62,482 14,406 15,975 13,726 27,395 11,785 10,839 492,890 Total 258,795 207,145 173,459 132,139 53,480 51,402 49,007 43,523 26,426 26,015 1,234,879

Fig. 6. Prevalence of major cancer sites by time since diagnosis on January 1, 2013 in Korea.

138 CANCER RESEARCH AND TREATMENT Kyu-Won Jung, Cancer Statistics in Korea, 2012

Table 10. Crude and age-standardized rates of cancer prevalence by sex on January 1, 2013 in Korea

Crude prevalence rate Age-standardized prevalence rate Site/Type per 100,000a) per 100,000b) Both Male Female Both Male Female All sites 2,452.8 2,175.0 2,730.9 1,649.2 1,592.2 1,788.0 Lip, oral cavity, and pharynx 33.8 45.7 22.0 23.0 33.2 14.3 Esophagus 14.8 26.7 2.9 9.5 19.3 1.6 Stomach 411.4 546.5 276.2 265.6 391.3 162.9 Colon and rectum 344.5 410.9 278.1 221.5 296.6 161.8 Liver 102.1 152.6 51.5 68.8 109.7 32.3 Gallbladderc) 29.4 29.9 28.8 18.4 21.6 16.0 Pancreas 14.0 15.1 12.8 9.2 10.9 7.7 Larynx 17.1 32.1 2.1 11.0 23.4 1.2 Lung 106.2 136.7 75.8 68.3 99.1 44.8 Breast 262.5 2.2 523.0 176.5 1.6 346.7 Cervix uteri 86.4 - 173.0 57.5 - 111.7 Corpus uteri 30.2 - 60.4 20.6 - 40.4 Ovary 28.1 - 56.3 20.3 - 40.2 Prostate 97.3 194.6 - 58.4 141.6 - Testis 4.4 8.8 - 4.0 7.8 - Kidney 51.7 69.7 33.6 35.4 50.5 22.1 Bladder 50.6 82.4 18.9 31.3 59.9 9.9 Brain and CNS 17.1 17.9 16.4 15.0 16.0 13.9 Thyroid 514.0 162.5 866.0 358.7 114.8 600.7 Hodgkin lymphoma 4.0 5.1 2.9 3.4 4.3 2.5 Non-Hodgkin lymphoma 52.5 56.8 48.2 38.7 44.3 33.8 Multiple myeloma 7.6 8.1 7.2 5.0 5.8 4.4 Leukemia 29.6 32.6 26.5 28.4 31.8 25.1 Other and ill-defined 143.4 138.4 148.3 100.5 108.6 93.9 CNS, central nervous system. a)Crude prevalence rate: number of prevalent cases divided by the corresponding person-years of observation; Prevalent cases were defined as patients who were diagnosed between January 1, 1999 and December 31, 2012 and who were alive on January 1, 2013; Multiple primary cancer cases were counted multiple times, b)Age-adjusted using the world standard population, c)Includes the gallbladder and other/unspecified parts of the biliary tract.

6. Survival rates rate in females might be explained in part by cancers common in females (e.g., thyroid and breast cancers) having The trends in relative survival for all sites combined relatively good prognoses. among both sexes by year of diagnosis from 1999 to 2012 are When examined by year of diagnosis and cancer site, the shown in Fig. 5. The relative survival for all sites combined 5-year relative survival rates appeared to be higher for most increased with year of diagnosis, and also increased when major cancers in patients diagnosed from 2008 to 2012 we excluded thyroid cancer cases in our analysis. compared with those diagnosed from 1993 to 1995, with the Table 9 shows the 5-year relative survival rates for four exception of pancreatic cancer. The greatest improvements diagnosis periods: 1993-1995, 1996-2000, 2001-2005, and 2008- were seen in cancers of the prostate, stomach, leukemia, 2012. The 5-year relative survival rate of patients diagnosed lip/oral cavity/pharynx, and non-Hodgkin lymphoma. The with cancer in the most recent period (2008-2012) was 68.1% improving survival rates could be attributable to early detec- for all sites combined in both sexes (59.6% in males and 76.6% tion and improved treatments [18,19]; however, this requires in females). When compared with earlier periods, notable further evaluation. Only pancreatic cancer showed no improvements in the 5-year relative survival rates were improvement in 5-year relative survival rate compared observed for all sites combined. The higher cancer survival with 1993-1995. A lack of progress in early detection and

VOLUME 47 NUMBER 2 APRIL 2015 139 Cancer Res Treat. 2015;47(2):127-141

treatment could explain the observed absence of improve- For all cancers combined in both sexes, the 2-5-year and ment in the survival rate for pancreatic cancer [20]. > 5-year prevalences accounted for 30.5% and 39.9% of the total prevalence, respectively. The long-term prevalences 7. Prevalence rates for lung and liver cancers were relatively low due to low survival rates of lung and liver cancer patients. The cancer prevalence rates by sex and cancer site on January 1, 2013 in Korea are shown in Table 10. The CRs per 100,000 of cancer prevalence for all sites combined were 2,175.0 and 2,730.9 in males and females, respectively, Conflicts of Interest and the ASRs per 100,000 of cancer prevalence for all sites combined were 1,592.2 and 1,788.0 in males and females, respectively. In males, the five leading primary sites of cancer Conflict of interest relevant to this article was not reported. for prevalence were stomach (CR, 546.5; ASR, 391.3), colon and rectum (CR, 410.9; ASR, 296.6), prostate (CR, 194.6; ASR, 141.6), thyroid (CR, 162.5; ASR, 114.8), and liver (CR, 152.6; ASR, 109.7), which together accounted for 67.4% of all preva- Acknowledgments lent cancer cases. In females, the most common cancer site was thyroid (CR, 866.0; ASR, 600.7), followed by breast (CR, 523.0; ASR, 346.7), colon and rectum (CR, 278.1; ASR, 161.8), This work was supported by a research grant from the stomach (CR, 276.2; ASR, 162.9), and cervix uteri (CR, 173.0; National Cancer Center (No. 1310220), Republic of Korea. ASR, 111.7), which together accounted for 77.5% of all preva- The authors are indebted to Korea Central Cancer Registry lent cancer cases. (KCCR)-affiliated hospitals, non-KCCR-affiliated hospitals, The prevalence by time since diagnosis is shown in Fig. 6. 11 regional cancer registries (the Busan, Daegu and Gyeong- For all cancers combined, the 2-year prevalence constituted buk, Gwangju and Jeonnam, Incheon, Daejeon, Ulsan, Gang- 29.6% of all prevalent cases. The 2-year prevalence, as a won, Chungbuk, Jeonbuk, Gyeongnam and Jejudo cancer percentage of the total prevalence, was highest for thyroid registries), the National Health Insurance Service and Statis- (23.1%), followed by stomach (14.5%) and colon and rectum tics Korea for data collection. (13.8%), which had high incidence rates and good prognoses.

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